Evaluation and Treatment Allocation of Skull Base Tumor Patients in a Multidisciplinary Radiation Oncology and Neurosurgery Central Nervous System Community Hospital Clinic

Introduction: Collaboration between Radiation Oncology and Neurological Surgery has rarely been implemented in the outpatient clinic setting. The vast overlap between these areas of expertise for patients with skull base lesions provides a great opportunity to examine treatment allocation for this patient population from a multidisciplinary approach.

Materials and Methods: Since the inception of our RADIANS (RADIation oncology And NeuroSurgery) multidisciplinary clinic at a community hospital, nine consecutive patients with skull base disease have been evaluated over an 18-month period. The fundamental idea of RADIANS was to establish a weekly time where patients could receive input from both disciplines during a single clinic visit. Disease and treatment demographics were collected and analyzed. Patient satisfaction was assessed via survey questionnaire.

Results: The distribution of primary versus metastatic skull base disease was nearly even (five primary, four metastatic), as was treatment allocation: four received radiation alone [one conventional fractionation, the other three stereotactic body radiation therapy (SBRT)], two received surgery alone, one received surgery with radiation (SBRT), and two were managed with observation. Mean patient age was 63.8 years (range 41–83), and the mean patient distance from our RADIANS clinic was 29.2 miles (range: 1.4–173). All responders found that having two physicians at the same time was “a better way to be evaluated than simply having two separate appointments with these two physicians,” while describing the dynamics of the evaluation process as being shared equally between the radiation oncologist and neurosurgeon; all would recommend RADIANS for a friend/relative with newly diagnosed disease.

Conclusion: Our findings indicate that patients with skull base disease treated through the RADIANS clinic model have received relative balance between treatment modalities, that skull base tumor patients are less likely to present with metastatic disease than the majority of patients seen in our clinic setting (McClelland et al, Abstract 1302, Congress of Neurological Surgeons 2018 Annual Meeting), and that the clinic model is popular with patients. Thoughtful staffing of the clinic with experienced technicians, dosimetrists, physicists, nurses and sub-specialty neurosurgeons and radiation oncologists provides the opportunity for a community hospital to provide quality care to patients who otherwise would not have cutting edge radiosurgical techniques and skull base surgical techniques available to them. As academic medical centers expand their reach into the community and create health systems of care located closer to patients, this clinic serves as a potential model of care for other academic medical centers expanding their service lines of subspecialty care.